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Staff VP GBD HEDIS/Interventions 95819

Company Name:
Anthem
Responsible for developing, implementing and leading strategy to ensure successful Medicaid and Medicare HEDIS Medical Record Review Strategy and Process, as well as the corporate GBD member and provider intervention strategies for quality management and improvement.
Primary duties may include, but are not limited to:
Develops, implements and leads strategies to ensure successful Medicaid and Medicare HEDIS Medical Record Review Strategy and Process, as well as the corporate GBD member and provider intervention strategies for quality management and improvement.
Leads the year round HEDIS chart collection and medical record review process as well as outreach, incentive and collaboration programs that will drive increased revenue for Medicaid value-based purchasing programs (VBP) and HEDIS Stars.
Monitors clinical quality measures and trends and formulates tactics, goals and strategies to improve clinical outcomes and reduce/manage costs.
Maintains compliance with all HEDIS technical specifications, NCQA HEDIS methodology for MRR process, CMS HEDIS Stars methodology for chart capture, state based VBP process, department, internal and 3rd party audit activities.
Leadership accountabilities include: Integration of initiatives that support the optimal use of resources, impacting quality outcomes (HEDIS) and performance as defined by quality line of business leaders, participation in CMS, state and local quality initiatives that meet the goals of state plan presidents, regional presidents and quality leaders and completion of deliverables to support health plans growth and success.
Hires, trains, coaches, counsels, and evaluates the performance of direct reports.
Requires a BA/BS degree, 8 years of related experience, with at least 3 years management experience in a health care environment, including National Committee for Quality Assurance (NCQA) and HEDIS; or any combination of education and experience, which would provide an equivalent background. MPH or MBA preferred. Knowledge of NCQA and Utilization Review Accreditation Commission ( URAC) accreditation requirements required.
EOE.M/F/Disability/Veteran
Job Medical
Title: Staff VP GBD HEDIS/Interventions 95819
Location: AZ-Scottsdate
Requisition ID: 95819

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